Chronic pain, seizures, and anxiety can all have a significant negative impact on your life. There are several options for treating these conditions, but for many people, pregabalin may be the answer.
Pregabalin, also known as Lyrica®, is a medication approved by the United States Food and Drug Administration (FDA) to treat neuropathic (nerve) pain, fibromyalgia, and certain types of seizures. This guide will explain the uses, benefits, side effects, and precautions associated with pregabalin.
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What is Pregabalin?
Pregabalin is an anticonvulsant medication structurally related to gabapentin but with distinct pharmacological properties.
Overview and History
Pregabalin was FDA-approved in December 2004 for the treatment of neuropathic pain. Subsequently, it was approved for treating fibromyalgia and managing neuropathic pain associated with spinal cord injuries. In 2017, the first extended-release form of the medication was approved for neuropathic conditions.
Mechanism of Action
Pregabalin works on a protein in calcium channels in the brain. Activating this protein, the alpha2-delta protein, increases calcium in nerve cells and decreases the amount of certain neurotransmitters that excite nerve cells (glutamate and substance P).
Uses of Pregabalin
Pregabalin is FDA-approved for neuropathic pain, seizures, fibromyalgia, and nerve pain associated with spinal cord injuries. Off-label use, such as for anxiety, should always be discussed with a healthcare provider. Neuropathic Pain Relief
Pregabalin was first approved for neuropathic pain. Neuropathic pain stems from the nervous system. Many conditions can cause neuropathic pain, including postherpetic neuralgia, spinal cord injuries, and diabetic neuropathy.
A review study showed that pregabalin was associated with a 30-50% pain improvement for patients with postherpetic neuralgia, at least 50% improvement in pain associated with diabetic neuropathy, and at least 30% in patients with pain associated with post-traumatic neuropathic pain or central neuropathic pain.
Epilepsy Management
Pregabalin is also approved for managing epilepsy. It is typically used as an adjunctive treatment, adding it to other medications rather than being a first-choice option.
Compared to gabapentin, pregabalin offers certain advantages as an anti-seizure medication because its dose-dependent effects allow for more predictable outcomes with dosage adjustments.
Generalized Anxiety Disorder (GAD)
Pregabalin shows some promise for the management of generalized anxiety disorder (GAD). GAD is a common condition, present in almost 6% of adults in the United States. Pregabalin is believed to affect the activation of certain parts of the brain that respond to emotional stimuli.
This has led to its off-label use for the treatment of GAD and social anxiety disorders. Pregabalin is often used as both a first-line and a second-line treatment for GAD. It’s also used to help improve sleep in patients with GAD.
Pregabalin Dosage and Administration
Pregabalin comes in multiple forms and strengths. This allows its titration to optimize effects while minimizing side effects.
Standard Dosages
The standard pregabalin dosage varies based on the condition used and the patient’s age. For:
- Diabetic neuropathy, pregabalin is often started at 50mg every 8 hours (regular release) or 165mg daily (extended-release).
- Postherpetic neuralgia, it is started at 50-150mg two to three times daily (regular release) or 165mg daily (extended-release).
- Seizure disorders, the dose is generally 50-75mg two to three times daily. Lower doses may be recommended in the case of conditions such as kidney impairment or in older patients.
Forms and Strengths
Pregabalin comes in three formulations and multiple strengths:
- Regular release capsules: 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, and 300mg
- Oral solution: 20mg/mL
- Extended-release tablets: 82.5mg, 165mg, 330mg
All forms of pregabalin are Schedule V controlled substances, meaning that it has low potential for abuse. Regardless, it should be taken under the supervision of a healthcare provider.
Adjusting Dosages
The dose of pregabalin may need to be adjusted based on the response to treatment and changes in health conditions such as kidney disease. A healthcare provider may adjust the dose based on individual response and tolerance, typically after one week of treatment.
The maximum dose of pregabalin is 600mg/day for immediate release or liquid and 660mg daily for the extended-release formulation, though this depends on the condition being treated.
It is important not to change your medication dose without your healthcare provider's guidance.
Side Effects and Safety Concerns
Pregabalin can be very helpful for patients, improving their quality of life, but it can also cause side effects. These can range from mild to life-threatening.
Common Side Effects
Some of the common side effects associated with pregabalin include:
- Dizziness
- Sleepiness
- Dry mouth
- Nausea or vomiting
- Swelling in the hands, feet, or ankles
- Weight gain
- Vision changes
- Constipation
- Decreased memory
- Loss of coordination
These conditions may not always require you to stop the medication. Consult your healthcare provider before decreasing or stopping the medication.
Serious Risks and Warnings
Pregabalin is associated with the risk of becoming dependent on the medication and may also be misused, which is the reason that it is now a Schedule V medication. Pregabalin carries black box warnings for misuse, abuse, dependence, and decreased breathing (respiratory depression).
Other serious side effects include:
- Chest pain
- Irregular heartbeat
- Seizures
- Abnormal muscle movements
- Altered mental status
- Suicidal thoughts
- Paranoia
- Delusions
- Severe allergic reactions
If you experience severe side effects associated with pregabalin, contact your healthcare provider for guidance immediately.
Pregnancy and Lactation
Pregabalin can cause serious fetal side effects if used during pregnancy, especially early pregnancy. For this reason, the medication should not be used in women who are pregnant or planning to become pregnant unless deemed necessary by a healthcare provider.
Pregabalin may be used during breastfeeding in certain circumstances, but it crosses into breast milk. Breastfeeding decisions should also be made in consultation with a healthcare provider.
Interactions with Other Medications
Pregabalin may interact with several different medications and other substances. Some of these include:
- Alcohol
- Allergy medications
- Anxiety and sleep medications
- Antidepressants
- Some blood pressure medications
- Other medication for seizure
- Some diabetes medications
- Some pain medications
- Medications for mental health conditions
It’s important to talk to your healthcare provider and your pharmacist about all medications you are taking to ensure that you are not taking anything that should not be combined with pregabalin.
Alternatives to Pregabalin
If pregabalin isn’t the right medication for you, there are alternatives that you may want to discuss with your healthcare provider.
Other Medications for Neuropathic Pain
Gabapentin is a common alternatives to pregabalin. Other alternatives include: duloxetine, amitriptyline, and carbamazepine.
Non-Medication Options
There are also non-medication options for the treatment of some of the conditions for which pregabalin is indicated. Alternative treatments such as acupuncture, physical therapy, and massage may complement traditional medications but should be discussed with your healthcare provider. For anxiety disorder, counseling may be an alternative to medication.
FAQs About Pregabalin
Who Should Not Take Pregabalin?
Pregabalin is only approved for pediatric use in children over 1-month-old with seizure disorders. It is not recommended for nerve pain in anyone under age 18. As mentioned previously, it is not recommended for use during pregnancy. It should be used with caution in patients over age 65 and those with kidney disease or a history of drug use or dependence.
How Long Does Pregabalin Take to Work?
Pregabalin may start working as quickly as one week, but this can vary. At the recommendation of your healthcare provider, the dose of pregabalin may be adjusted as soon as one week after starting it.
What to Do If You Miss a Dose?
If you miss a dose of pregabalin, you should take it as soon as you remember unless you are close to your next dose. Do not take more than one dose at a time unless your healthcare provider instructs you to do so.
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Key Takeaways
- Primary Uses: Pregabalin is FDA-approved for managing neuropathic pain, fibromyalgia, seizures, and nerve pain from spinal cord injuries. It is also used off-label for conditions like generalized anxiety disorder (GAD).
- Mechanism of Action: Pregabalin modulates calcium channels in the brain, reducing the release of excitatory neurotransmitters like glutamate and substance P, which helps manage nerve-related pain and seizures.
- Dosage and Administration: Pregabalin is available in various formulations (capsules, oral solution, and extended-release tablets) with dosages tailored to the treated condition. A healthcare provider should guide adjustments.
- Safety Concerns: Common side effects include dizziness, sleepiness, and swelling, while serious risks include dependency, respiratory depression, and rare allergic reactions. It carries an FDA black box warning for misuse and abuse.
- Pregnancy and Breastfeeding: Pregabalin is generally not recommended during pregnancy due to potential fetal harm. Decisions about breastfeeding while using pregabalin should be made in consultation with a healthcare provider.
- Drug Interactions: Pregabalin can interact with alcohol, anxiety medications, antidepressants, and other drugs, emphasizing the importance of discussing all medications with a healthcare provider.
- Alternative Treatments: Options like gabapentin, duloxetine, or non-medication therapies such as acupuncture and physical therapy may complement or substitute pregabalin for specific conditions. These should also be discussed with a healthcare provider.
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